If a patient is suspected to suffer from Factitious Disorder or Munchausen’s Disorder, the hospital and office records would indicate that he has done this repeatedly (and likely successfully). Thus, you would know that he has obtained (or tried to obtain) unnecessary surgeries and other procedures with very little effort.
However, there are those who have a unique form of malingering in which they create symptoms and seek procedures including surgery because they are fearful that their current symptoms. Since, in the future, they may not have medical benefits, they seek the procedures now while they are insured.
They are, indeed, aware that their symptoms are either not as severe as they are alleging. Driven by fear, they consciously amplify those symptoms because they strongly believe that they are headed toward the need for the surgery at some future time in life.
They often have just enough medical information to falsify their complaints and enough information to frighten themselves regarding their future need for surgery.
Such patients can be confronted in a kind-firm manner such that “there are no indications that you will ever need the surgery you are seeking. Surgery when it is not clearly indicated is a far greater risk to you.” But you then must help them deal with their fears of an uncertain future that they have created for themselves in fantasy.
Not all malingering has as its goal financial remuneration; sometimes the tangible goal being sought is largely one based upon fear.